This pilot proposal is in response to an RFA to Prevent or Reduce Oral Health Disparities and seeks to establish a collaborative study partnering the periodontal and molecular epidemiology expertise at the University of North Carolina School of Dentistry with the Obstetrics/Gynecology expertise at the University of Hawaii School of Medicine to examine the role of periodontal disease in pre-term deliveries among pregnant diabetic Asian & Pacific Islander (API) women. This is an understudied minority population with a high prevalence of both diabetes and pre-term delivery. Periodontal disease is an oral infection that is more severe among diabetics and also increases insulin resistance among diabetics. Periodontitis also is associated with increased risk for pre-term delivery, pre-term premature rupture of membranes and growth restriction. Diabetes among pregnant women is a risk factor for both pre-term delivery and macrosomia. Thus, we seek to examine whether periodontal infection among diabetic women may provide some contribution to the observed high rate of pre-term delivery among API diabetics. Specifically, this proposal seeks to conduct a pilot case-control study to determine the extent of periodontal disease in API diabetic (Type 1, Type 2 or gestational) and non-diabetic women who have term and pre-term deliveries (<37 weeks gestational age). Approximately 92 diabetic and 92 non-diabetic pre-term delivery API mothers and 184 diabetic and 184 non-diabetic term delivery API mothers will be studied (frequency matched on race 1 case: 2 controls). Full-mouth periodontal examinations will be performed using standardized methods and calibrated examiners. Preliminary data will be generated by analyzing fetal cord blood for markers of fetal exposure to oral pathogens of maternal origin, as indexed by bacterial-specific fetal IgM levels and fetal stress as reflected by slCAM and CRP levels. In addition a subset of fetal membranes will be analyzed for protein expression of IL-lb, TNFa and IL-6 by ELISAs and MMP-8 mRNA by Northerns. Pilot data will be generated to support an R01 application that will originate from the U of H (a minority institution) with Dr. Millar as PI, to test the hypothesis that periodontitis is more extensive among API diabetic women and associated with higher rate of fetal exposure to oral pathogens than among non-diabetics and that the prevalence of periodontal disease and frequency of fetal exposure is higher among pre-term deliveries for both diabetics and non-diabetics, as compared to term deliveries. In this collaboration UNC will also provide the U of H study personnel the periodontal and molecular epidemiology research training and experience needed in multi-disciplinary studies of periodontal disease and obstetrics to conduct the planned R01 application.